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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2006

01-01-2006 | Original Article

Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node

Authors: Aeisha K. Rivers, MD, Kent A. Griffith, MS, MPH, Kelly K. Hunt, MD, Amy C. Degnim, MD, Michael S. Sabel, MD, Kathleen M. Diehl, MD, Vincent M. Cimmino, MD, Alfred E. Chang, MD, Peter C. Lucas, MD, Lisa A. Newman, MD, MPH, FACS

Published in: Annals of Surgical Oncology | Issue 1/2006

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Abstract

Background

The survival benefit of a completion axillary lymph node dissection (ALND) in patients after removal of a metastatic sentinel lymph node (SLN) is uncertain and is under study in ongoing clinical trials. The completion ALND remains necessary, however, for the identification of cases with at least four metastatic lymph nodes, in which extended-field locoregional and/or postmastectomy radiation will be recommended. Our goal was evaluate clinicopathologic features that might serve as surrogates for determining which patients with a positive SLN are likely or unlikely to belong to this high-risk subset.

Methods

Records were reviewed for 285 patients from 2 comprehensive cancer centers who underwent completion ALND after resection of a metastatic SLN from 1995 to 2002. Clinicopathologic features were analyzed by univariate and multivariate logistic regression. Forty-one cases (14%) were found to have at least four positive nodes after ALND.

Results

Fisher’s exact test revealed the following features to be significantly (P < .05) associated with having four or more nodal metastases: tumor size >2 cm, lymphovascular invasion, an increasing ratio of positive SLNs to the total number of resected SLNs, extranodal extension, and the size of the SLN metastasis. Patients whose largest SLN metastasis was <2 mm had only a 1.4% risk of having four or more metastatic nodes (P < .0001).

Conclusions

We conclude that patients with SLN micrometastases face an extremely low likelihood of having extensive nodal disease on completion ALND. Patients with larger primary tumors, lymphovascular invasion, and extranodal extension are more likely to have ALND findings that will affect their cancer management.
Literature
1.
Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 2002;347:567–75CrossRef
2.
Wilke LG, Giuliano A. Sentinel lymph node biopsy in patients with early-stage breast cancer: status of the National Clinical Trials. Surg Clin North Am 2003;83:901–10CrossRef
3.
4.
Van Zee KJ, Manasseh DM, Bevilacqua JL, et al. A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 2003;10:1140–51CrossRef
5.
Degnim AC, Griffith KA, Sabel MS, et al. Clinicopathologic features of metastasis in nonsentinel lymph nodes of breast carcinoma patients. Cancer 2003;98:2307–15CrossRef
6.
Recht A, Edge SB, Solin LJ, et al. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001;19:1539–69CrossRef
7.
Recht A, Edge SB. Evidence-based indications for postmastectomy irradiation. Surg Clin North Am 2003;83:995–1013CrossRef
8.
Krag D, Weaver D, Ashikaga T, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 1998;339:941–6CrossRef
9.
Wong SL, Edwards MJ, Chao C, et al. Predicting the status of the nonsentinel axillary nodes: a multicenter study. Arch Surg 2001;136:563–8CrossRef
10.
Chu KU, Turner RR, Hansen NM, et al. Do all patients with sentinel node metastasis from breast carcinoma need complete axillary node dissection? Ann Surg 1999;229:536–41CrossRef
11.
Abdessalam SF, Zervos EE, Prasad M, et al. Predictors of positive axillary lymph nodes after sentinel lymph node biopsy in breast cancer. Am J Surg 2001;182:316–20CrossRef
12.
Erickson VS, Pearson ML, Ganz PA, et al. Arm edema in breast cancer patients. J Natl Cancer Inst 2001;93:96–111CrossRef
13.
Engel J, Kerr J, Schlesinger-Raab A, et al. Axilla surgery severely affects quality of life: results of a 5-year prospective study in breast cancer patients. Breast Cancer Res Treat 2003;79:47–57CrossRef
14.
Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993;2:335–9; discussion 340CrossRef
15.
Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 1994;220:391–8; discussion 398–401CrossRef
16.
Zavagno G, De Salvo GL, Casara D, et al. Sentinel node biopsy for breast cancer: is it already a standard of care? A survey of current practice in an Italian region. BMC Cancer 2004;4:2CrossRef
17.
Torrenga H, Fabry H, van der Sijp JR, et al. Omitting axillary lymph node dissection in sentinel node negative breast cancer patients is safe: a long term follow-up analysis. J Surg Oncol 2004;88:4–7; discussion 7–8CrossRef
18.
Rietman JS, Dijkstra PU, Geertzen JH, et al. Treatment-related upper limb morbidity 1 year after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast cancer. Ann Surg Oncol 2004;11:1018–24CrossRef
19.
Reitsamer R, Peintinger F, Prokop E, et al. 200 Sentinel lymph node biopsies without axillary lymph node dissection—no axillary recurrences after a 3-year follow-up. Br J Cancer 2004;90:1551–4CrossRef
20.
Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349:546–53CrossRef
21.
Kuerer HM, Sahin AA, Hunt KK, et al. Incidence and impact of documented eradication of breast cancer axillary lymph node metastases before surgery in patients treated with neoadjuvant chemotherapy. Ann Surg 1999;230:72–8CrossRef
22.
Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997;15:2345–50CrossRef
23.
Borgstein PJ, Pijpers R, Comans EF, et al. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998;186:275–83CrossRef
24.
Albertini JJ, Lyman GH, Cox C, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996;276:1818–22CrossRef
25.
Shahar KH, Hunt KK, Thames HD, et al. Factors predictive of having four or more positive axillary lymph nodes in patients with positive sentinel lymph nodes: implications for selection of radiation fields. Int J Radiat Oncol Biol Phys 2004;59:1074–9CrossRef
Metadata
Title
Clinicopathologic Features Associated With Having Four or More Metastatic Axillary Nodes in Breast Cancer Patients With a Positive Sentinel Lymph Node
Authors
Aeisha K. Rivers, MD
Kent A. Griffith, MS, MPH
Kelly K. Hunt, MD
Amy C. Degnim, MD
Michael S. Sabel, MD
Kathleen M. Diehl, MD
Vincent M. Cimmino, MD
Alfred E. Chang, MD
Peter C. Lucas, MD
Lisa A. Newman, MD, MPH, FACS
Publication date
01-01-2006
Publisher
Springer New York
Published in
Annals of Surgical Oncology / Issue 1/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.03.080

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